Calling the shots

Medical students apply vaccination skills

Stanford's student-run Flu Crew, co-directed by Rachel Risal (right) and Rishi Mediratta, delivers no- and low-cost vaccinations to members of the community.

Stanford medical student Rishi Mediratta vividly remembers the first time he gave someone a flu shot. “It was with a third-year medical student, and I was very nervous about having to stick a needle in someone,” said the future physician. But thanks to the training he received as part of the school’s student-run influenza-prevention program, “My first patient didn’t even feel the needle.”

Now more than a year later, Mediratta is co-director, along with fellow second-year medical student Rachel Rizal, of Flu Crew. Officially called the Medical Student Influenza Prevention Program, Flu Crew delivers no-cost vaccinations to people at Stanford and in the local community to reduce the burden of influenza and improve public health. It is the largest medical school program of its kind in the country.

Making an impact

Flu Crew began in 2001, when Walter Newman, MD, a family physician and adjunct associate professor, taught several first-year Stanford medical students how to give flu shots. Since then, more than 25,000 no- or low-cost vaccinations have been administered by student volunteers.

Flu Crew participation is practically a rite of passage for incoming medical students these days: 75 percent of first-year students in 2010 and 60 percent in 2011 took part in the program. At the beginning of the school year, students are taught about the pathophysiology and epidemiology of the influenza virus, which is associated with 3,000 to 49,000 deaths annually, according to the Centers for Disease Control and Prevention. Students are also given hands-on training on administering vaccines.

Last year, with vaccines and supplies donated by Vaden Health Center, Stanford University Occupational Health Center and the Santa Clara County Public Health Department, as well as support from numerous Stanford faculty and physicians, Flu Crew volunteers vaccinated more than 4,000 people, including more than 1,000 on the Stanford campus. The students have brought their services to churches, homeless shelters and free clinics; in 2010, they offered free or low-cost vaccines to voters at two polling stations in Palo Alto and San Jose.

Personal touch

“What makes our program unique is that we deliver health care to where people eat, live and work,” said Rizal, who has a particularly fond memory of working last year with a low-income mom and her three young children at a church in San Jose.

“They didn’t know much about vaccinations in general, and I brought them all in a circle and talked about the risks and benefits,” she recalled. “I felt like I was educating an entire family and preventing them from becoming sick.”

Both Rizal and Mediratta had done public-health projects before coming to Stanford. Rizal joined a World Health Organization project aimed at increasing hepatitis B vaccinations among newborns in the Philippines, and Mediratta worked on preventive health services for Ethiopian children. Both consider Flu Crew a “natural extension” of their previous work.

“The programs all have a similar goal of protecting a population,” said Mediratta, noting that 42 percent of vaccines administered in 2011 were provided to low-income individuals in Santa Clara County.

Faculty advisor Pat Fast, MD, PhD, an adjunct associate professor, counts the group’s work with this population among its greatest achievements. “Last year, we vaccinated several hundred homeless individuals, a group that is at very high risk of complications from influenza, and a particular high point was immunizing women and their children at the battered women’s shelter in San Jose,” said Fast, who is also chief medical officer for the International AIDS Vaccine Initiative. “I’m sure this spares serious illness, possibly death, and also minimizes public expenditures for care.”

Hands-on training

Aside from providing an important service to the community, the program helps participating medical students by giving them early clinical exposure. First-year students don’t always have the opportunity to work directly with patients, but Flu Crew allows them to practice how to greet, treat and even thank patients.

“You’re learning to build rapport with a patient,” said Rizal. “It’s a good position to be in as a first-year medical student.”

As for the future, Flu Crew is thinking big—with a goal of providing 6,000 vaccinations in the community this fall. The program is now partnering with Khan Academy, a nonprofit that offers free educational materials, in developing an online training module. Training documents and instructions were recently shared with the University of California, San Francisco, which now has a similar program. Flu Crew also is integrated into Stanford’s medical school curriculum, ensuring that all future students are trained in vaccination.